Provider Demographics
NPI:1134225105
Name:DUHAIME, MELISSA RENEE (PT)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:RENEE
Last Name:DUHAIME
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:RENEE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1715 LILABERRY LN
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-8742
Mailing Address - Country:US
Mailing Address - Phone:850-217-9088
Mailing Address - Fax:
Practice Address - Street 1:1715 LILABERRY LN
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-8742
Practice Address - Country:US
Practice Address - Phone:850-217-9088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT17375225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCS189YOtherMEDICARE PTAN
FLY906WOtherBCBSFL GROUP #